BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    50-12734 LAPAROSCOPY BASIN

    MDR report key: 413749 · Received August 23, 2002

    Report

    Report Number
    2320762-2002-00006
    Event Type
    Malfunction
    Date Received
    August 23, 2002
    Report Date
    July 22, 2002
    Manufacturer
    DEROYAL INDUSTRIES, INC.
    Product Code
    KDD
    Product Problem
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    NC, US
    Reporter Occupation
    OTHER

    Narratives

    Description of Event or Problem · 1

    NEEDLE COUNTER HINGES ARE BREAKING AND MAGNETS ARE NOT HOLDING.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 50-12734 LAPAROSCOPY BASIN CONVENIENCE PACK KDD DEROYAL INDUSTRIES, INC. NA UNK

    Patients

    Seq Age Sex Outcome Treatment
    1 UNKNOWN Other